Defining the medical profession in mid-nineteenth century Bristol.

The movement for reform of medical practice which occupied the middle decades of the nineteenth century culminated in the Medical Registration Act of 1858. Its provisions were a disappointment to many reformers because, among other things, it did not allow automatic prosecution of unqualified practitioners. They could only be penalised if they assumed a medical title or passed themselves off as registered practitioners. Newman1 comments that 'the Act turned out as well as it did because it did so little'

Registration Act of 1858. Its provisions were a disappointment to many reformers because, among other things, it did not allow automatic prosecution of unqualified practitioners. They could only be penalised if they assumed a medical title or passed themselves off as registered practitioners. Newman1 comments that 'the Act turned out as well as it did because it did so little' but, at least, initiation of the Medical Register seems to mark an important stage in defining who were to be, and who were not to be, considered as members of the medical profession. Doctors saw such definition as urgent, particularly at the interface between the formally qualified and those practitioners sanctioned only by tradition. It is therefore worth asking how effective the act was in achieving it. Some evidence may be provided by studying medical practitioners in a defined area before and after 1858. The providers of medical treatment in the Bristol and Clifton area in 1851 have already been surveyed, using the enumerators' books of the census and the corresponding Bristol directories.2 To provide comparable information on medical practice after 1858, similar methods have now been applied to the directories and enumerators' books for 1861.

UNQUALIFIED 'SURGEONS'
The most obvious group for study is that made up of individuals without formal qualifications but calling themselves 'surgeons', the description adopted by the majority of general practitioners qualified MRCS or LSA, or both. Twenty-three unqualified surgeons were identified in 1851, as against seventy-three regularly qualified general practitioners. Census returns show seven of the twenty-three without qualifications as being over 57 years old and therefore probably entitled to practise because the Apothecaries' Act of 1815 legalised unlicensed persons already practising before that date. Two others implied by their entries in directories that they were in this category, but in one case the claim is open to doubt. The surgeon concerned was Joseph Furze and he is discussed individually below, as also are others who illustrate the careers open to unqualified practitioners. Of the remaining fourteen unqualified surgeons of 1851, eight were only found in the census returns or very briefly in the directories as well. They would form a most interesting group but little is known of them apart from what appears in the enumerators' books. Excluding them leaves six individuals who had more established practices and could still be identified in 1861. By that time four had qualified MRCS, leaving only two still unqualified: these were James Butcher and James E. Leaker who are discussed below. By 1861, more than two years after the registration act, and despite delays in its implementation, this category of practitioner might be expected to have disappeared. This was not the case though their number had more than halved while that of the corresponding qualified practitioners had increased slightly.
Ten individuals were recorded as practitioners in the directories or enumerators' book but had no traceable qualifications. Half of these, however, were only found in the single census return and in no other source: and only one of these was the head of a household, the other four being recorded as visitors or lodgers. Another, found briefly in the directories, was simply recorded as J. Smith and it is difficult on this rather general description to be certain that he was not formally qualified. And one other was a surgeon already accepted as being in practise in 1815. This leaves only three Furze and Leaker as already mentioned, and a practitioner of similar background named Christopher Liddon. Herapath. The coroner said Furze represented himself as a surgeon but appeared in the directories as a druggist. Again the jury was told the formal qualifications were immaterial and returned a verdict of death from natural causes.6 Furze claimed legality by being in practice before 1815. This is possible as, according to census returns, he would have been 19 at the time: but he did not appear on the Medical Register after the act, suggesting that he could not prove his point.
Christopher Liddon also claimed to have been in practice before 1815 but census returns show that he would have been only 15 and, not surprisingly, he also did not appear on the register. In the 1840s he had been a chemist and dentist and then switched to being a surgeon and chemist. In the 1861 census he appeared only as a chemist, but in the directories was still described as a surgeon as well.
The last of those for individual discussion is James The medical Registration Association for Bristol, Bath and neighbourhood was founded late in 1859 and seems to have been preceded by a Bristol association.8 Before 1858, the Apothecaries' Act of 1815 was occasionally used as a legal weapon against the unqualified. At Bristol assizes in 1846, the Company successfully prosecuted a person called Wall for practicising as an apothecary without their license.9 The regular practitioners also tried to exert pressure through coroners' courts where they held a strong position, being called on to establish the cause of death. But, as already illustrated, formal medical qualification was not an issue in these courts.
In both the inquests mentioned, William Bird Herapath was involved. This may be a coincidence or it may be that Herapath was, for one reason or another, particularly anxious to expose the 'quacks'. His interest in forensic chemistry may have made him alert to the possibilities of therapeutic misadvanture and, practising from Old Market, he was close to areas rich in unqualified practitioners.2 The medical profession, particulaly when urging medical reform, had to be seen to be above reproach and this is illustrated by an incident involving the Herapaths. A Mr. W. Herapath, presumably the surgeon's father who was a respected citizen and a distinguished toxicological chemist, was required at Bristol Quarter Sessions to pay nominal damages for kissing the attractive 20-year old wife of James Wildgoose, a brick and tile maker. This resulted in a ballad on the subject being sung in the Bristol streets, and the rapid appearance of a note in the newspapers that the Herapath concerned was not the medical member of the family.10 'CONFIDENTIAL MEDICAL ADVICE' One type of irregular practice was conspicuous because it was carried out through advertisements for confidential medical advice in conditions which might range from venereal disease to impotence. The practitioners were often described as consulting surgeons or physicians, and some published booklets, designed presumably to frighten suggestible patients to consult them in the belief that they suffered from venereal infections or from what was described as the results of solitary indulgence. In the survey of 1851, three such businesses were found by their newspaper advertisements: two of the individuals involved were also identified in the enumerators' books where both prudently described themselves only as medicine vendors. Anderson and Henry claimed that they held the Apothecaries' license, but usually it is difficult to locate the individuals behind the advertisements and highly likely that many were not medically qualified. Some firms may have taken the precaution of recruiting a qualified partner after 1858, as is suggested by an advertisement quoted in the Lancet for a medically qualified man to join an 'Advertising Medical Consulting Practice'.12 The advertisements of this type of practitioner roused indignation both by the indelicacy of the matters discussed, even if only obliquely, and by the style of practice they reflected. Square turned out to be Isaac Jacques who was summoned on information laid by Dr. Macdonald. A young ship's mate had read Blake's publication entitled The Secret Preceptor which alarmed him into seeking advice at the author's address where Jacques presented himself as 'the doctor', diagnosed a serious case without examining the patient, supplied medicines and extracted payment. Apparently the case for the Registration Association was not sufficiently supported in some respect and the charge was dismissed, though Jacques was clearly not medically qualified and seems to have been taking the title of doctor.16 Even if unsuccessful, legal actions must have persuaded practitioners of this type to alter their strategy. Certainly no offers by Bristol practitioners of confidential medical advice framed in the characteristic manner were found in the Bristol Mercury for 1861. One possible change of tactics was discussed by a Bristol surgeon writing to the Lancet.
He suggested that all an irregular practitioner need do was to pay the patent medicine tax and see that all his preparations carried the government stamp: he would then be safe from the law.17 PRESCRIBING DRUGGISTS AND OTHERS Individuals practicing as chemists and unqualified surgeons who were identified in the census returns have already been discussed. A further eleven persons described both as surgeons and as chemists or druggists were found in newspapers or directories between 1841 and 1861. Three had regular medical qualifications and were legitimately combining the two activities. This was not considered unusual in the 1840s as was shown by an advertisement in a newspaper for a good retail drug business in Bristol, stating that 'a surgeon would find it an excellent opportunity'.18 Persons combining both activities were less common in the 1850s, after 1858 none was found other than those already discussed. Many irregular practitioners may simply have called themselves druggists, and there seems little doubt that a great deal of 'counter practice' was done by chemists and druggists in Bristol and elsewhere.2 There were numerous other groups offering medical treatment, including mesmerists, medical galvanists and herbalists. Scraps of evidence suggest also that a great deal of informal healing was practiced, for example by the stone mason 'who had acquired a reputation for curing all sorts of diseases',19 or treatment for enlarged glands in the neck by a woman from Lawrence Hill 'who professed to be skilful in such cases'.20 Most of these practitioners do not concern us as they did not assume a medical title, though a few did. Among them were the American herb doctors who are discussed elsewhere;21 but it is worth recording here one success for the Medical Registration Association. This was in the case of Thomas Airey, a herb doctor whose flamboyant had failed to deal with the problem and this view accords with the early findings from Bristol. This is, however, to focus on a negative aspect of the act and its significance was not that it failed to penalise a small section of outsiders, but rather that the inception of the General Council and the Medical Register was an important step towards defining and formalising the boundaries of the medical profession.